Insurance Verification

We understand that treatment options can sometimes seem not affordable and overwhelming. We are here to help find the best options at the lowest cost to you. Private insurance is accepted, to have one or more of our facilities complete a verification of benefits, please include the following information:

  • Name of patient:
  • Patient DOB:
  • Subscriber Name:
  • Subscriber DOB:
  • Subscriber home address:
  • Name of insurance company:
  • Member ID#:
  • Group#:
  • Insurance company phone number:
  • Presenting mental health and/or substance abuse issue:
  • Current medical issues (if any):
Email: Insurance Verification

If your device does not have email button functions copy and paste the following email address into your email to us:

Web Form Email:

The person entering the program.

If the client is covered under another parties insurance, that party would be the subscriber and their name would be used here.

Street, City, State / Province / Region, Zip, Postal Code, Country


Mother, Father, Husband, etc

This information can be found on the back of the card. We accept number for Mental Health, Provider Contact Number or Customer Service Number

Usually on the front of the card

Add the number here if there is one

So we can contact you after our evaluation.

Mental Health Recovery

  • Psychiatric Medication Withdrawal
  • Opiate Detox
  • Holistic Mental Health